Individual provider Active NPI

Diane M Cymerman, PTA

  • Physical Therapy Assistant
  • Tinley Park, IL
National Provider Identifier
1114547106
Registry record updated Apr 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
160000516 Issued in IL
Practice address
8949 Glenshire St
Tinley Park, IL 60487-4417
Phone
(708) 478-7052
NPI assigned
Apr 20, 2020
Last updated
Apr 22, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 160000516 IL Primary

Addresses

Primary practice location

8949 Glenshire St
Tinley Park, IL 60487-4417

Mailing address

8949 Glenshire St
Tinley Park, IL 60487-4417
Phone (708) 478-7052

Other identifiers 3

IdentifierTypeStateIssuer
000516OtherILPTA LISCENSE
000516OtherILPTA
000516OtherILLISCENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
160000516ILMDPhysical Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587513600000",
    "number": "1114547106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8949 GLENSHIRE ST",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604874417",
            "telephone_number": "708-478-7052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8949 GLENSHIRE ST",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604874417",
            "telephone_number": "708-478-7052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CYMERMAN",
        "first_name": "DIANE",
        "middle_name": "M",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-20",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160000516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTA LISCENSE",
            "identifier": "000516",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTA",
            "identifier": "000516",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LISCENSE",
            "identifier": "000516",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tinley Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.